Provider Demographics
NPI:1568859338
Name:SRI WELLNESS CENTER
Entity Type:Organization
Organization Name:SRI WELLNESS CENTER
Other - Org Name:ADDISON DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SREELEKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-627-7626
Mailing Address - Street 1:190 N SWIFT RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101
Mailing Address - Country:US
Mailing Address - Phone:630-627-7626
Mailing Address - Fax:
Practice Address - Street 1:190 N SWIFT RD
Practice Address - Street 2:SUITE G
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1476
Practice Address - Country:US
Practice Address - Phone:630-627-7626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.026520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty